Understanding and Managing Pain

Recently the use of prescription pain medication in the United States has gone under scrutiny. This topic has hit especially hard in western New York. As a physical therapist, a majority of patients I see are experiecing pain. I spend my day teaching people how to manage pain with movement vs. a pill.

In order to properly manage pain, we must understand what pain is. The World Health Organization defines pain as follows: “Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.” Let’s break that definition down a little further.

Pain as a sensory and emotional experience

Pain is an extremely complex sensation, which each person responds to differently. Notice how that definition reports pain is a SENSORY and EMOTIONAL experience? Personal bias, emotional response, and past experiences all influence our unique experience of pain. For example; if two people get a bee sting in the exact same spot and of the same intensity, will they experience the same pain? The answer is no. Pain is more than a simple mechanical injury.

To understand pain, we must first have knowledge of the nervous system and how everything is tied together. The first link in the chain is a mechanical input (the bee sting). The sting causes an injury, which sets off a series of nerve signals. A sensory nerve will send a message to the spinal cord and then to the brain. The brain quickly interprets the signal and then sorts it into a painful or non-painful category. Think of it like an old operator switch board. The brain has a choice based on past experiences, perceived threat level, current emotional state, and other inputs on how to interpret the signal.

Based on previous experiences and your perceived level of threat; your brain will send specific signals which dictate the intensity, location, and type of pain you experience. Meaning, no two people experience the same response to pain because our unique life experiences play a key role in the interpretation of a painful stimulus. This is evident every day in patients with “the same injury.” Two patients present with knee arthritis, however one can run for miles while the other is unable to walk.

Pain as a Perceived Threat

The second part of the definition states that pain is associated with tissue damage or even the PERCEIVED THREAT of tissue damage. Meaning even if there is no evidence of “an injury,” our body can experience pain if there is a precieved threat. This is evident when someone with back pain has a “normal” MRI. Pain may be present without an anatomical reason.

The idea of the brain perceiving a threat without tissue damage is helping us understand and manage chronic pain. One in ten Americans suffer from chronic pain (1). Chronic pain carries a significant physical, emotional, social, and financial burden on its victims. New research is linking how people manage pain to the likelihood of becoming a chronic pain sufferer (1).

It is believed that people who constantly worry about hurting themselves can heighten the brains sensitivity to pain (2). These people typically experience higher levels of pain than someone who is not always focused on pain. It is the same principle from when you were a child getting a shot. The doctor would say they would “stick you” on the count of three, and then actually gave you the injection on the count of two. This trick would reduce the pain. Think about it, if you are constantly thinking “is this going to hurt?” the chances of it hurting are greater.

Now that we have a better idea of how pain occurs, what can we do to eliminate pain? We know it is more complicated than just resolving the injury (i.e. tissue damage). It seems we should focus our attention on the emotional response to pain. A simple way to start is to become more educated about your pain. Keep in mind that your mood, associated feelings, and attitude influence how you feel pain. Understanding why pain is occurring, learning ways to cope, and actively working to resolve any damage are great ways to start feeling better today!